midterm.txt

• Also known as adrenergic nervous system
• Uses adrenaline (epinephrine) as primary neurotransmitter
• Used in expenditure of energy and response to threatening stimuli
• FIGHT or FLIGHT Reaction

• Also known as the cholinergic nervous system
• Uses acetylcholine as primary neurotransmitter
• Used in conservation and restoration of energy
• For rest and digestion

• Eye: Dilated pupil (improves far vision)
• Heart: Increased rate of contraction, Increased force of contraction, Coronary artery dilation
• Lungs: Dilation of bronchi
• Blood vessels: Vasodilation, except Kidney
• GI tract: Little effect on muscle tone or secretions, increased sphincter tone

• Eye: Constricted pupil (improves close up vision)
• Heart: Slowed heart rate, Decreased force of contraction, Coronary vasoconstriction
• Lungs: Bronchoconstriction
• blood vessels: No effect, only has effect on skin (Vasodilation)
• GI tract: Increased muscle tone and peristalsis

• Ephedrine (Increases blood pressure)
• Clonidine (Centrally acting, decreases blood

Tamsulosin (Benign prostatic hyperplasia)

• Beta 2 Selective: lbuterol (Bronchodilator), Salmeterol (Bronchodilator)
• Nonselective: Epinephrine,

• Nonselective: Propranolol
• Beta 1 Selective: Atenolol (Hypertension, angina), Metoprolol (Hypertension, angina)

• Direct-Acting; Cholinergic Drugs: Pilocarpine (Glaucoma)
• Indirect-Acting Cholinergic Drugs: Edrophonium (Diagnosis of myasthenia gravis)

Tolterodine (Overactive bladder)

• In some patients, the heart looses its ability to pump effectively. This causes the heart to pump out less blood than it receives leading to several undesirable effects:
• left side failure, blood backs up in the lungs and breath difficulties
• right side failure, fluid builds up in the abdominal cavity and legs

• Digitalis purpurea (Foxglove)
• Digitalis lanata (Deadly nightshade)

• Increase the force of contraction of the heart
• Decrease heart rate
• Decrease atrioventricular conduction

• Loading Dose (Digitalization): 0.5 to 1.5 mg in 12-24 hour period.
• Maintenance Dose: 0.125 mg to 0.5 mg/day
• Therapeutic Blood Levels: 1 to 2 mcg/L

• Nausea and vomiting
• Headache
• Yellow-green visual disturbances, halos
• Cardiac arrhythmia's

• Low Potassium (Hypokalemia): sensitize the heart to the toxic effects of cardiac glycosides. Increase risk of toxicity Arrhythmia�s and death
• High Potassium (Hyperkalemia): block the therapeutic effects of cardiac glycosides.

• Digoxin
• Diuretics: Furosemide, hydrochlorothiazide, reduce edema and fluid retention
• ACE Inhibitors: enalapril, lisinopril, ramipril. Decrease blood pressure; allow heart to pump more blood with less effort
• ARB�s: Valsartan and other -sartan
• Carvedilol (Coreg�): nonselective beta blocker and alpha1 receptors, helps the heart work better as a pump
• Nesiritide (Natrecor): recombinant form of human B-type natriuretic peptide (hBNP). Nesiritide relaxes smooth muscle tissue and leads to reduced arterial pressure and improvement in shortness of breath.

Angina is chest pain caused by insufficient blood flow to the heart muscle.

Decreased blood flow (ischemia) to the heart results in decreased oxygen available to heart muscle. When oxygen deprivation becomes severe enough, heart muscle may be damaged and myocardial infarction (heart attack) can result.

Decreased blood flow (ischemia) to the heart results in decreased oxygen available to heart muscle. When oxygen deprivation becomes severe enough, heart muscle may be damaged and myocardial infarction (heart attack) can result.

• dilation of arteries and veins.
• decreases the amount of blood returned to the heart
• decreases blood pressure.
• reduce coronary vasospasm

• Sublingual Nitroglycerin (Nitroquick�): for acute anginal attacks.
• Transdermal Nitroglycerin (Nitro-Dur?, Transderm-Nitro?) to prevent angina attacks.
• Nitroglycerin for IV Infusion: acute events.
• Nitroglycerin Ointment 2%
• Nitroglycerin Extended Release Tablets/Capsules

• Must be stored in light-resistant, airtight containers
• Should not use if tablets are more than 6 months old
• Used transdermal patches still contain small amounts of drugs.

• Beta Blockers: prevent or reverse this sympathetic stimulation.
• ACE Inhibitors: lower blood pressure, allowing the heart to pump more blood with less effort.
• ARB�s
• Aspirin: produces a rapid antithrombotic effect.
• Clopidogrel (Plavix�): causes an antithrombotic effect by inhibiting platelet aggregation.
• Ca Channel Blockers: cause vasodilation, decreasing cardiac work and oxygen demand.

• Nitroglycerin(Nitroquick�, Nitro-Dur?, Transderm-Nitro?)
• Isosorbide Dinitrate (Isordil)
• Isosorbide Mononitrate (ISMO�, Imdur?)
• Atenolol (Tenormin�) selective to heart
• Metoprolol (Lopressor?) selective to heart
• Aspirin
• Clopidogrel (Plavix�)
• Amlodipine (Norvasc�)
• Diltiazem (Cardizem?, Dilacor?, Tiazac?)
• Nicardipine (Cardene)
• Nifedipine (Adalat?, Procardia?)
• Verapamil (Calan, Isoptin)

• Excrete most of the end products of body metabolism
• Control the concentration of most of the constituents of body fluid, a constant blood volume and amounts of solutes in the blood
• Maintain the pressure of blood flow

Acetazolamide (Diamox�): emergency situation, pressure in the eye

Furosemide (Lasix�): oral

• Hydrochlorothiazide (Hydrodiuril�, Dyazide?, Maxzide)
• Triamterene (Dyazide, Maxzide)
• Metolazone (Zaroxolyn)

• Orthostatic Hypotension: older people tends to have more
• Hyperglycemia
• Potassium Loss

• Aldosterone Antagonist, Aldosterone causes Na and fluid retention.
• used in conjunction with other diuretics to prevent potassium loss.
• Few side effects, mainly elevated potassium levels.

• Acts directly on the distal convoluted tubules to cause diuresis while inhibiting potassium excretion.
• used in conjunction with other diuretics to prevent potassium loss.

• Hypertension
• Congestive Heart Failure
• Post MI
• Increase K level

• Angiotensin II Receptor Antagonists
• Hypertension
• Congestive Heart Failure
• Post MI
• Diabetic nephropathy
• Have no effect on k level

• impacts the rennin/angiotensin system.
• Aliskiren (Tekturna�): Hypertension

• Hydrochlorothiazide
• Triamterene, Dyazide�, Maxzide�: Hyperkalemia
• ACE Inhibitors: Hyperkalemia
• ARB�s : has little effect on potassium concentrations.
• Aliskiren (Tekturna�): Hyperkalemia

Blood pressure is a measurement (usually in millimeters of mercury) of the amount of pressure being exerted on the walls of the arteries by the blood.

Usually defined as blood pressure of greater than 135/90

• Hypertension
• Angina pectoris
• Arrhythmias
• Post myocardial infarction
• Migraine headaches
• Anxiety
• Side effects: Mask the signs of hypoglycemia in patients with diabetes

• Alpha Blockers: Terazosin (Hytrin?), Doxazosin (Cardura?), Prazosin (Minipres?)
• Alpha Agonists: Clonidine (Catapres?), Guafacine (Tenex?), Guanabenz (Wytensin?)

When calcium moves through the "slow channels" in the smooth muscles of arteries, vasoconstriction occurs. Calcium channel blockers inhibit this process, thus causing vasodilation.

• Arrhythmias
• Angina
• margin headache

• Amlodipine (Norvasc�)
• Verapamil (Calan, Isoptin)

Phospholipids

• Help absorb fat
• Necessary for the clotting process
• Part of the sheath that insulates nerve fibers
• Part of the membrane of almost all cells in the body

• Atherosclerosis is a condition in which lipid deposits (cholesterol) adhere to the walls of the arteries.
• Atherosclerotic plaques cause the walls of the arteries to become inflexible and thus loose their ability to stretch. Hypertension
• Areas of the arteries where atherosclerotic plaques are present are more likely to rupture. Cerebral hemorrhage, renal hemorrhage, retinal hemorrhage.
• Atherosclerotic plaques can protrude into a vessel and decrease blood flow to the organ or tissue. Angina, ischemia, MI.
• Protruding atherosclerotic plaques make great places for clots to form.

• Total cholesterol: Less than 200 mg/dL
• LDL (bad) cholesterol: Less than 100 mg/dL (70)
• HDL (good) cholesterol: 60 mg/dL or higher (65)
• Triglycerides: Less than 150 mg/dL

• Increase or decrease in amount of cholesterol ingested: alter LDL cholesterol levels
• Diet high in saturated fat: increase LDL cholesterol levels by about 15 to 25%
• Weight: Losing weight can lower LDL cholesterol and triglycerides while raising HDL cholesterol
• Physical Activity:lower LDL cholesterol and raise HDL cholesterol
• Lack of thyroid: increase LDL cholesterol levels
• Diabetes: LDL cholesterol levels rise very high
• Higher levels of estrogen: decrease LDL cholesterol levels
• Age and Gender: LDL cholesterol levels tend to increase with age
• Heredity

Inhibit the enzyme HMG Co-A reductase an enzyme required in the formation of cholesterol by the liver. Very effective in lowering LDL cholesterol levels.

• Reduces level of plasma proteins that carry cholesterol.
• Lowers LDL cholesterol and triglycerides
• raises HDL cholesterol
• Most common side effects include headache and flushing.

• Cholestyramine (Questran�)
• Colestipol (Colestid�)
• Bind cholesterol in the GI tract for excretion into the feces.
• Used to lower LDL, cholesterol levels.

Reduces the absorption of cholesterol from the GI tract.

• Mainly Inhibits triglyceride synthesis.
• Used to treat elevated triglyceride levels.

Used to treat elevated triglyceride levels.

• Inhibits thrombin so that fibrin cannot be formed
• Inhibits thromboplastin so that thrombin cannot be formed
• Interferes with platelet aggregation
• Rapid onset of action (within 5 minutes)
• Short duration of action (2 to 4 hours)
• Cannot be given orally because it is destroyed by gastric acid, IV sub

• The structure of warfarin is very similar to the structure of Vitamin K. When the liver tries to use warfarin instead of Vitamin K to produce clotting factors, abnormal clotting factors are formed.
• Slow onset of action (12 to 72 hours)
• Long duration of action (2 to 10 days), stop it at least one week before op.
• Highly protein bound (this creates lots of drug interactions)
• Very narrow therapeutic range

• Hemorrhage, bruise, International Normalized Ratio (INR) to reduce.
• Thromboembolism

• Pentoxifylline (Trental�)
• Reduces blood viscosity
• Improves erythrocyte flexibility
• Indication: intermitted claudication

• Recommended dose is 400 mg TID, only can change to BID
• Slow onset of action (2 to 4 weeks)
• Controlled release tablet - cannot half
• May cause nausea and vomiting

• Clot formation begins when platelets aggregate or �stick� together. These drugs inhibit platelet aggregation, thus preventing clot formation.
• Prevention of stroke in patients at high risk for stroke or who have previously suffered a stroke (Plavix?, Ticlid?)
• Myocardial infarction prophylaxis (Aspirin - Bayer?, Ecotrin?)
• Intermittent claudication (Pletal?)

• Clopidogrel (Plavix?)
• Aspirin (Bayer?, Ecotrin?)
• Cilostazol (Pletal?)
• Prasugrel (Effient)
• Ticlopidine (Ticlid?) amnia,

The human body has the ability to resist almost all types of organisms or toxins that tend to damage the tissues and organs.

• The substances that the immune system attacks.
• Bacteria, Viruses, Toxins

• Humoral Immunity
• B-cells (Bursa of Fabricus)
• Also formed before and shortly after birth
• Fights slowly growing bacteria

• Smaller substances that must combine with a protein to become an antigen.
• Drugs
• Dust
• Dander
• Chemicals
• Smoke

• Blood vessels
• Bronchial smooth muscles
• Intestinal smooth muscles

• Stomach
• Heart
• Blood vessels
• Uterine tissue

• Promethazine (Phenergan� - used for nausea)
• Tripelennamine (PBZ?)
• Azatadine (Optimine?)
• Azelastine (Astelin? - nasal spray)
• Clemastine (Tavist?)
• Cyproheptadine (Periactin - used for itching, appetite stimulating)
• Dexchlorpheniramine (Polaramine)
• Diphenhydramine (Benadryl) sleep-aid
• Hydroxyzine (Atarax, Vistaril - used for itching, nausea)
• Meclizine (Antivert, used for nausea and dizziness/vertigo)

• Fexofenadine (Allegra)
• Desloratidine (Clarinex)
• Levocetirizine (Xyzal): OTC
• Bepotastine (Bepreve? - ophthalmic drug)
• Olopatadine (Patanol? - ophthalmic drop, eye contact)

None

• Intranasal steroids are very effective in preventing acute allergic attacks.
• Budesonide (Rhinocort)
• Fluticasone (Flonase)
• Mometasone (Nasonex)

• These agents inhibit leukotrienes. Leukotrienes are released in the nasal passages after allergen exposure and lead to the symptoms of allergic rhinitis.
• Montelukast (Singulair)

narrowing of the bronchioles (bronchoconstrictor) due to contraction of smooth muscles. This can be caused by allergies, irritation, exercise, or other factors. It is associated with inflammation.

inflammation of the bronchi. A patient that has excess mucous secretions on most days for 3 months of the year is said to have chronic bronchitis.

a breakdown in the walls of the alveoli which causes a decrease in oxygen diffusion into the blood. Smoking, miners

• Steroids decrease bronchoconstriction by decreasing the inflammatory response of the bronchi.
• Oral Steroids: Prednisone (Deltasone�), Methylprednisolone (Medrol�)
• Inhalation Steroids: Fluticasone (Flovent?), Budesonide (Pulmicort?), Triamcinolone (Azmacort?), Flunisolide (Aerobid?), Mometasone (Asmanex?)

• Xanthines
• Not sure how these drugs work, they work intracellularly like the beta agonists, thus causing bronchodilation.
• useful for maintenance therapy
• Side effects: Nausea/Vomiting, Increased heart rate, Seizures, Arrhythmia�s

• Cholinergic Antagonist: Ipratropium (Atrovent�), Tiotropium (Spiriva�)
• Combination Products: Salmeterol/Fluticasone (Advair Diskus�), Albuterol/Ipratropium (Combivent?)
• Antileukotrienes: Montelukast (Singulair?), Zafirlukast (Accolate?), Zileuton (Zyflo?)
• Xanthines: Theophylline (Theo-Dur), Aminophyllin (Aminophylline)
• SRS-A Inhibitor: Cromolyn (Intal)
• Anti-inflammatory: Nedocromil (Tilade)
• Expectorants: Guaifenesin, Iodine
• Mucolytics: Acetylcysteine (Mucomyst?), Dornase Alfa (Pulmozyme?)

none

• Guaifenesin: Decreases viscosity and stickiness of mucus, OTC cough preparations (Robitussin�)
• Iodine: break up mucus. Iodine is secreted in with mucus and breaks it up, making for easier elimination.

• used by inhalation. They physically break up mucus for expectoration.
• Acetylcysteine (Mucomyst?): Used for Tylol overdose
• Dornase Alfa (Pulmozyme?)